Kelly Hamoudah, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.010600 Issued in IL

Practice address

1100 31St St
Downers Grove, IL 60515-5509

Phone

(630) 469-9200

NPI assigned

Aug 26, 2020

Last updated

Oct 12, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other names 1

• Kelly Andresen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1558974873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 31ST ST",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605155509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 31ST ST",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605155509",
            "telephone_number": "630-469-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMOUDAH",
        "first_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-26",
        "last_updated": "2021-10-12",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "POSTDOC",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.010600",
            "primary": true
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "ANDRESEN",
            "credential": "M.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lalaine Halum
• Jillian Hamblin
• Malak Hamdan
• Andrew P Hamilton, MS, LPC
• Stephanie Hammer-McGrady, PT, DPT
• Ashwin Vagesh Hampole, MD
• Tracy Diane Hand, OTR/L
• Alexander Hannah, AM, LCSW
• Jennifer Hannan, M.D.
• Michelle Marie Hansen, M.A. CCC-SLP

• Clinical Psychologist in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.